Doctor Answers 24

The differences in facelifts are significant. The idea of a facelift with a ‘short scar’ appeals to the consumer, but the term is quite misleading. It leads one to believe that you can get the same result with a shorter scar, and the reality is that you can’t. It sounds too good to be true, and it is. In fact the logic behind these procedures really defies logic. View my facial rejuvention gallery (link below)

Short scar???

The ‘short scar’ and MACS facelifts eliminate the incisions behind the ears, which – if carried out correctly – should result in invisible scars. Scars behind the ears, when placed where they belong (in the depth of the crease behind the ears and hidden in the occipital hairline) are either invisible or very difficult to detect. So why all the fuss? Because a lot of surgeons are not meticulous about making and closing the incisions behind the ears, which has given these scars a bad name. But there is no reason it has to be that way.

Hey, what are those odd scars in front of your ears?

The MACS facelift moves ALL of the skin excision into the area in front of the ear, which forces the surgeon to create a gathered, pleated and essentially impossible-to-conceal closure around the patient’s sideburns. With a traditional facelift closure the scar in this area may be placed behind the temporal hairline, where it is invisible, or at the hairline, where it can be closed invisibly because much or most of the skin excess has been removed behind the ears.

The MACS lift does something that is completely counter-intuitive: moving the surgical scars from areas where they are easily concealed to areas where they are almost impossible to conceal. The term ‘short scar facelift’ is really misleading, as you go from longer scars that can be completely concealed to shorter scars that can’t. So effectively, in terms of visible scars, the ‘short scar’ facelifts are in reality LONGER VISIBLE SCAR facelifts.

They are also - as they undermine less skin and undertreat or completely fail to treat neck skin laxity - less of a facelift. And not really a necklift at all, which all facelifts should be.

Um, your neck still looks old.

There’s just no way around it. In patients with neck skin laxity, if you fail to fully mobilize the skin of the neck as well as below and behind the ears, then it is physically impossible to create a smooth, dramatic and truly rejuvenation neck contour. Unless, as a cosmetic plastic surgeon, you are willing to leave a pile of skin folds and pleats in the lateral neck below the ear. I have yet to meet the patient who will be happy with a sort-of youthful anterior neck but an aged and post-surgical looking lateral neck. And I would derive no joy from providing a patient with that kind of surgical result.Spend some time carefully studying ‘short scar’ facelift (‘MACS lift’ ‘S-lift’, ‘weekend facelift’, ‘Lifestyle Lift’, etc.) before and after photos. You will see, over and over, the following features:

Easily visible scars in the sideburn area and in front of the ears

Distortion of normal sideburn anatomy

Gathering of skin (pleats and wrinkles) below the ears

Undesirable skin contours below the jawline and in the neck

Little to no improvement in neck skin laxity

of course you may also see unfavorable scars in traditional facelift ‘before and after’ photos, so you need to carefully research the physician or physicians you decide to consult with for a facelift procedure. If a surgeon has mastered the High-SMAS face and necklift procedure, the scars should be close to invisible and often undetectable. This procedure, combined with structural fat grafting, rejuvenates the face in a very dramatic yet still very natural-appearing way. And with scars that allow a patient to wear their hair any way they please, including pulled back in a ponytail or gathered up above the ears.

Understanding terminology is useful in determining what will work for you

July 21st, 2009

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Unlike many facial and or plastic surgeons I have performed nearly every type of facelift from subcutaneous to SMAS to "Deep Plane" Composites, MACS, Short Scars and even Lifestyle Lifts .

I am a facelift specialist and have performed as many as 300 in a year and 10 in a week. Recently we introduced the first laser assisted facelift the LaserSmartLift which we now perform as our standard procedure. It is a new approach that combines short recovery times with exceptional results.

The most important thing to discuss is what you want corrected and the ability of the surgeon to effect this with his operation (whichever one is selected). Many problems can not be optimally corrected with short scars and short flaps. A full face lift involves a very long flap and usually side to side neck dissection and in some patients this may be the best option. Most patients will fare well with an intermediate flap and standard minilift incision that extends partly into the back hairline. Excessive neck laxity may require a longer incision. Think correction not operation Jowls, Nasal Labial Folds, Neck Bands, Neck Laxity. Ask your surgeon how the operation he selects will do in the areas you want corrected the most. No one facelift will optimally correct all those factors so if they offer one size to fit all you may want to seek another opinion. Less is not better Better is Better.

Many Techniques

October 25th, 2010

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Traditional Facelift: usually refers to an incision that starts in the hairline above the ear, extends around the ear and curves back either into- or along the hairline behind the ear. The lifting techique varies from "skin only," to various SMAS and deep plane techniques.

MACS (Minimal Access Cranial Suspension) Lift: as the name implies, MACS uses a short scar incision, purse string sutures in the SMAS to lift and tighten facial structures.

Short Scar refers to the limitation of the incision, usually just below the side-burn, along the front of the ear, aaround the ear lobe and a short distance behind the ear.

Facelift Pictures

More Facelift Techniques than there are Faces to Lift!

July 26th, 2010

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While there is clearly science involved in achieving a good facelift result, there is a whole lot of art as well. Every time one of my colleagues manages to get a good result with a slighlty shorter scar, or performs a facelift in a different plane it tends to get press.

The truth is that you need a surgeon who understands your specific needs should tailor an operation for you. Of course, the trick is the find a surgeon who shares your basic philosophy about how invasive you want to be and how natural you should look when the procedure is done.

Different facelift techniques

August 12th, 2009

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There are many different variations of facelifting techniques. A short scar facelift is a technique that attempts to remove excess skin through a short scar. If there is excess skin and significant aging process, then a full face/neck lift has to be performed. Otherwise, excess pleats of skin will result with a short scar. A MACS facelift is a more vertically oriented facelift, which does not address neck issues. It does not address excess skin in the neck, muscle bands, cords or subplatysmal and submental fat. A traditional facelift addresses the jowling process, excess skin, muscle banding in the neck, subplatysmal and supraplatysmal fat as well as tying the muscles in the front part of the neck, the back portion of the neck, and tightening the SMAS layer.

It's not the name but what it does that matters

July 22nd, 2009

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The traditional facelift involves an incision that starts in the hairline above the ear, extends along the front boarder of the ear, around the lobe, behind the ear and into the hairline. There are numerous variations on this but that's the basics. After this the skin and a small amount of fat is lifted across the entire neck and cheeks to the mid-cheek region. After this several things can be done: 1 The next layer of tissue, abbreviated as the SMAS, can be lifted onto itself and stitched. This is called plication. I don't feel that it gives as good a result as...2. Lifting the SMAS off of the deeper tissues, elevating it vertically, removing the excess and suturing it to the bone. I find this give an excellent elevation of the mouth and jowls. The excess skin is removed and the incisions closed. In addition the neck muscles may or may not be tightened in the midline. This surgery is the gold standard and is good for patients with significant extra skin and facial sagging but can be used on anyone.

The MACS (minimal access cranial suspension lift) involves the same or somewhat less skin elevation. Then the SMAS is elevated by two or three stitches that are passed through the layer in long loops then tied to the deep tissues above the ear. It's a great surgery for many but in particular moderate excess skin and deep tissue descent.

Minimal scar only means a shorter scar than the standard lift. This can involve only behind the ear for a neck lift or in front of the ear for a MACS or similar lift.

It's not the surgical technique the matters. What matters is what the most appropriate surgery for the patient is.

Traditional, MACS, vs short scar: here are the basics

July 20th, 2009

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The other respondants have done a great job discussing the very important aspects of choosing a surgeon, as well as the confusion that exists due to the differing terminology used to describe a myriad of facelift procedures. To simplify, though, here are the basic answers to your question.

A traditional facelift (as the term is most commonly used) involves quite a bit of tissue dissection, widespread undermining of the tissues, and a lifting or tightening of the deeper tissues. In general, you can assume that the best results are acheived with this approach.

The MACS lift is a simpler approach, with less dissection, less undermining, and a simplified suture technique to lift the tissues of the jowl and neck. The incision runs in front of the ear like a facelift, but not behind the ear. Not all patients are good candidates for this, but in some patients its a good option. (nearly as good as a facelift.)

Short scar is a catch all phrase - can be used for a variety of "minilift" approaches. Similar to the MACS lift - for most patients wont produce as much improvement as a traditional facelift, but has the advantage in the minds of many patients of being "less invasive."

Facelift surgery is an art form

July 19th, 2009

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Like almost no other plastic surgery operation, face lift surgery is an art form. The results of no 2 surgeons will be the same even with the same starting point. This is a critical thing for patients to realize!

The patient should not be terribly concerned with the "name" of the procedure, ie. MACS lift, deep plane, SMAS lift, short scar technique etc. The technical details are mostly beyond the layman's comprehension and to further confuse you there is a huge amount of overlap between these techniques. Further, there is no standardization of exactly what these terms mean to different surgeons.

What DOES matter though is looking at multiple photos of multiple patients whom that surgeon has operated on and seeing in those results what you would wish for yourself. Here you will see the true art of that particular surgeon!

So do your research carefully and remember that no 2 surgeons are the same and that in most instances, you get what you pay for so don't go for the discounted surgeons or the face lift assembly lines like the Lifestyle Lift.

Traditional Facelift vs Macslift

November 20th, 2013

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The Traditional facelift uses longer incisiones that can reach up into the hairline and extend behind the ear and the back of the neck. This facelift is more aggressive, more risky and a much longer recovery because the dissection goes under the muscle and also be extended to the mouth and neck.

Macslift which means Minimial Access Cranial Suspension Lift. This procedure tightens and lifts the neck, removes jowels and redefines the jawline and also pins the muscles of the midface back up taking 10 - 15 years off the face with natural long lasting results. This technique offers a shorter incision that runs slightly above the ear along the hairline, around the ear and sometimes extended behind the ear. The underlying muscles are pulled up but not dissected. The downtime is minimal and there is a very low risk of complications

Customize Facelift procedure to your needs

The mini-lifts may be tough to choose from because of all the brand names such as LifeStyle Lift, S-Lift, Quick Lift, LiteLift, MACS and others. They focus on improvement of the lower face and upper neck (jowls, marionette lines, upper neck loose skin).

The tradition facelift/necklift is best if you have a large amount of redundant skin and fat or turkey waddle deformity especially the lower neck. A skilled and experienced board certified plastic surgeon will steer you in the right direction

These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.